Multiple House Occupancy is Associated with Mortality in Hospitalised Patients with Covid-19

Bruce, Eilidh; Carter, Ben; Quinn, Terence J; Verduri, Alessia; Pearson, Oliver; Vilches-Moraga, Arturo; Price, Angeline; McGovern, Aine; Evans, Louis; McCarthy, Kathryn; Hewitt, Jonathan; Moug, Susan; Myint, Phyo K; behalf of COPE Study Team,; Einarsson, Alice; Fleck, Anna; Bisset, Carly; Alexander, Ross; Guaraldi, Giovanni; Murphy, Caroline; Kelly, Joanna; Short, Roxanna; Braude, Philip; El Jichi Mutasem, Tarik; Singh, Sandeep; Paxton, Dolcie; Harris, Will; Hesford, James; Holloway, Mark; Mitchell, Emma; Rickard, Frances; Galbraith, Norman; Bhatti, Emma; Edwards, Jenny; Duffy, Siobhan; Barlow-Pay, Fenella; Pearce, Lyndsey; Garcia, Madeline; Sangani, Shefali; Kneen, Thomas; Lee, Thomas; Davey, Charlotte; Jones, Sheila; Lunstone, Kiah; Cavenagh, Alice; Silver, Charlotte; Telford, Thomas; Simmons, Rebecca; Stechman, Michael

BACKGROUND: In response to the COVID-19 pandemic, many countries mandated staying at home to reduce transmission. This study examined the association between living arrangements (house occupancy numbers) and outcomes in COVID-19. METHODS: Study population was drawn from the COPE Study, a multicentre cohort study. House occupancy was defined as: living alone; living with one other person; living with multiple other people; or living in a nursing/residential home. Outcomes were time from admission to mortality and discharge (Cox regression), and Day-28 mortality (logistic regression), analyses were adjusted for key comorbidities and covariates including admission: age; sex, smoking; heart failure; admission CRP; COPD; eGFR, frailty and others. RESULTS: 1584 patients were included from 13 hospitals across UK and Italy: 676 (42.7%) were female, 907 (57.3%) were male, median age was 74 years (range: 19-101). At 28 days, 502 (31.7%) had died. Median admission CRP was 67, 82, 79.5 and 83mg/L for those living alone, with someone else, in a house of multiple occupancy and in a nursing/residential home, respectively. Compared to living alone, living with anyone was associated with increased mortality: within a couple (aHR 1.39, 95%CI 1.09-1.77, p = 0.007); living in a house of multiple occupancy (aHR=1.67, 95%CI 1.17-2.38, p = 0.005); and living in a residential home (aHR=1.36, 95%CI 1.03-1.80, p = 0.031). CONCLUSION: For patients hospitalised with COVID-19, those living with one or more people had an increased association with mortality, they also exhibited higher CRP indicating increased disease severity suggesting they delayed seeking care.